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中华老年骨科与康复电子杂志

中华老年骨科与康复电子杂志 ›› 2022, Vol. 08 ›› Issue (01) : 18 -23. doi: 10.3877/cma.j.issn.2096-0263.2022.01.004

骨质疏松

PKP术中不同注入量高粘度骨水泥治疗骨质疏松性腰椎骨折的疗效分析
刘军1, 方振林1,†()   
  1. 1. 435000　黄石中医医院骨科
  • 收稿日期:2020-05-16 出版日期:2022-02-05
  • 通信作者: 方振林
  • 基金资助:
    武汉市科技局应用基础研究计划项目(20150601010061)

The efficacy and safety of PKP with different doses of high-viscosity bone cement in the treatment of osteoporotic lumbar vertebral fracture

Jun Liu1, Zhenlin Fang1,†()   

  1. 1. Huangshi Hospital of traditional Chinese Medicine, Department of Orthopedics, Huangshi 435000, China
  • Received:2020-05-16 Published:2022-02-05
  • Corresponding author: Zhenlin Fang
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刘军, 方振林. PKP术中不同注入量高粘度骨水泥治疗骨质疏松性腰椎骨折的疗效分析[J]. 中华老年骨科与康复电子杂志, 2022, 08(01): 18-23.

Jun Liu, Zhenlin Fang. The efficacy and safety of PKP with different doses of high-viscosity bone cement in the treatment of osteoporotic lumbar vertebral fracture[J]. Chinese Journal of Geriatric Orthopaedics and Rehabilitation(Electronic Edition), 2022, 08(01): 18-23.

目的

探讨经皮椎体后凸成形术（PKP）术中不同注入量高粘度骨水泥治疗骨质疏松性腰椎骨折（OLVF）的疗效及安全性。

方法

前瞻性收集2016年9月至2018年9月本院OLVF患者150例，男84例，女66例，年龄（60±8）岁。依据随机数字表分为高量组、中量组、低量组，每组50例，高量组、中量组、低量组PKP术中高粘度骨水泥注入量分别为5.0~7.0 ml、3~4.9 ml、<3.0 ml，比较三组疗效及安全性。

结果

150例患者获得满意随访，随访时间（19±7）个月。高量组、中量组、低量组手术时间、术中出血量比较，差异无统计学意义（P>0.05）；高量组和中量组术后3、6个月椎体前缘高度[（27.3±3.1）mm、（26.0±2.7）mm和（26.9±3.0）mm、（25.7±2.8）mm]明显高于低量组[（23.8±2.8）mm、（21.3±2.5）mm]，高量组和中量组术后3、6个月Cobb角及疼痛视觉模拟评分法（VAS）、Oswestry功能障碍指数问卷表（ODI）评分[（40.2±4.7）°、（41.5±4.8）°、（2.6±0.4）分、（1.6±0.3）分、（25.8±3.5）分、（26.9±3.5）分和（40.9±4.8）°、（42.1±4.8）°、（2.6±0.4）分、（1.6±0.3）分、（26.2±3.5）分、（27.2±3.7）分]明显低于低量组[（46.3±5.3）°、（47.8±5.6）°、（3.3±0.4）分、（2.3±0.4）分、（33.3±4.1）分、（34.3±4.2）分]，差异有统计学意义（F=25.371、18.914、29.334、22.457、34.276、30.217、29.364、20.071，均P<0.001）；高量组骨水泥渗漏率（28.00%）明显高于中量组和低量组（8.00%和4.00%），差异有统计学意义（χ2=10.241，P=0.005）。

结论

PKP术中不同注入量高粘度骨水泥治疗OLVF的疗效及安全性存在一定的差异，其中注入中量（3~4.9 ml）高粘度骨水泥可获得良好的疗效及安全性，值得临床推广。

关键词: 经皮椎体后凸成形术, 注入量, 高粘度骨水泥, 骨质疏松性腰椎骨折, 安全性
Objective

To discuss the efficacy and safety of percutaneous kyphoplasty (PKP) with different doses of high-viscosity bone cement in the treatment of osteoporotic lumbar vertebral fracture (OLVF).

Methods

The 150 patients with OLVF in our hospital from September 2016 to September 2018 were selected, there were 84 males and 66 females, aged (60±8) years. They were divided into high-dose group, medium-dose group and low-dose group according to the random number table, 50 cases in each group. The injections of high-viscosity bone cement were 5.0-7.0 ml, 3-4.9 ml and <3.0 ml in high-dose group, medium-dose group and low-dose group respectively, and the efficacy and safety of the three groups were compared.

Results

The 150 patients were followed up satisfactorily for (19±7) months. There was no significant difference in operation time and intraoperative bleeding between high-dose group, medium-dose group and low-dose group (P>0.05). The anterior height of vertebral body in high-dose group and medium-dose group [(27.3±3.1)mm, (26.0±2.9)mm and (26.9±3.0)mm, (25.7±2.8)mm] was significantly higher than that in low-dose group [(23.8±2.8)mm, (21.3±2.5)mm] at 3 and 6 months after operation, the Cobb angle, pain visual analogue score (VAS) and Oswestry dysfunction index (ODI) scores in high-dose group and medium-dose group [(40.2±4.7)°, (41.5±4.8)°, (2.6±0.4) scores, (1.6±0.3) scores, (25.8±3.5) scores, (26.9±3.5) scores and (40.9±4.8)°, (42.1±4.8)°, (2.6±0.4)scores, (1.6±0.3) scores, (26.2±3.5) scores, (27.2±3.7) scores] were significantly lower than those in low-dose group [(46.3±5.3)°, (47.8±5.6)°, (3.3±0.4)scores, (2.3±0.4) scores, (33.3±4.1) scores, (34.3±4.2) scores] at 3 and 6 months after operation, the difference was statistically significant (F=25.371, 18.914, 29.334, 22.457, 34.276, 30.217, 29.364, 20.071, all P<0.001). The leakage rate of bone cement in high-dose group (28.00%) was significantly higher than that in medium-dose group and low-dose group (8.00% and 4.00%), the difference was statistically significant (χ2=10.241, P=0.005).

Conclusions

There are some differences in the efficacy and safety of different doses of high-viscosity bone cement in the treatment of OLVF during PKP, and the middle dosage (3-4.9 ml) of high-viscosity bone cement can achieve good efficacy and safety, it's worth for further clinical promotion.

Key words: Percutaneous kyphoplasty, Doses, High-viscosity bone cement, Osteoporotic lumbar vertebral fractures, Safety
表1 三组骨质疏松性腰椎骨折患者一般资料比较
组别 例数 性别（例，男/女） 骨折椎体（L1/2/3/4） 年龄（岁， ±s） 体质量指数（kg/m2， ±s） 骨质疏松病程（年， ±s） 椎体塌陷度（%， ±s）
低量组 50 28/22 16/14/12/8 60±8 23.6±2.6 6.5±0.7 48±5
中量组 50 26/24 18/12/10/6 59±8 23.5±2.6 6.4±0.8 49±5
高量组 50 30/20 14/16/10/10 60±8 23.8±2.6 6.6±0.7 49±6
χ2/F值   0.934 1.071 0.724 0.824 0.782 0.992
P值   0.304 0.244 0.426 0.371 0.403 0.251
表2 三组骨质疏松性腰椎骨折患者手术情况比较（±s）
组别 例数 手术时间（min） 术中出血量（ml） 骨水泥注入量（ml）
低量组 50 30±6 7.2±1.4 2.2±0.5
中量组 50 31±6 7.5±1.4 3.7±0.6
高量组 50 32±6 7.6±1.4 6.1±0.6
F值   1.367 1.036 37.261
P值   0.182 0.276 <0.001
表3 三组骨质疏松性腰椎骨折患者椎体前缘高度比较（mm，±s）
组别 例数 术前 术后3个月 术后6个月
低量组 50 15.2±1.9 23.8±2.8 21.3±2.5
中量组 50 15.3±1.8 26.9±3.0a 25.7±2.8a
高量组 50 15.1±1.9 27.3±3.1a 26.0±2.9a
F值   0.934 25.371 18.914
P值   0.327 <0.001 <0.001
表4 三组骨质疏松性腰椎骨折患者Cobb角比较（°，±s）
组别 例数 术前 术后3个月 术后6个月
低量组 50 62.5±6.8 46.3±5.3 47.8±5.6
中量组 50 62.9±6.9 40.9±4.8a 42.1±4.8a
高量组 50 62.6±6.7 40.2±4.7a 41.5±4.8a
F值   0.836 29.334 22.457
P值   0.407 <0.001 <0.001
表5 三组骨质疏松性腰椎骨折患者VAS评分比较（分，±s）
组别 例数 术前 术后3个月 术后6个月
低量组 50 7.6±0.8 3.3±0.4 2.3±0.4
中量组 50 7.5±0.8 2.6±0.4a 1.6±0.3a
高量组 50 7.6±0.8 2.6±0.4a 1.6±0.3a
F值   1.036 34.276 30.217
P值   0.271 <0.001 <0.001
图5~6 女，77岁，低量组骨质疏松性腰椎骨折患者。图5术前X线片；图6术后X线片
表6 三组骨质疏松性腰椎骨折患者ODI评分比较（分，±s）
组别 例数 术前 术后3个月 术后6个月
低量组 50 64.2±6.9 33.3±4.1 34.3±4.2
中量组 50 64.0±6.8 26.2±3.5a 27.2±3.7a
高量组 50 64.9±7.0 25.8±3.5a 26.9±3.5a
F值   0.762 29.364 20.071
P值   0.432 <0.001 <0.001
表7 三组骨质疏松性腰椎骨折患者骨水泥渗漏比较[例（%）]
组别 例数 椎间盘 椎旁 静脉 渗漏率
低量组 50 1（2.00） 1（2.00） 0（0.00） 2（4.00）a
中量组 50 1（2.00） 2（4.00） 1（2.00） 4（8.00）a
高量组 50 6（12.00） 6（12.00） 2（4.00） 14（28.00）
χ2值         10.241
P值         0.005
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